MEDICARE: PETER A. IRACE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	34.033568	OH

General Provider Information

NPI Number	:	1235213281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A. IRACE DO

Provider Business Mailing Address
First Line	:	611 W TURKEYFOOT LAKE RD
Second Line	:	STE D
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319
Country	:	US
Telephone Number	:	330-645-1600
Fax Number	:	330-645-1488

Provider Business Practice Location Address
First Line	:	611 W TURKEYFOOT LAKE RD
Second Line	:	STE D
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319
Country	:	US
Telephone Number	:	330-645-1600
Fax Number	:	330-645-1488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/20/2017

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